Full Arch DS Signature™ Workflow - Practice to Lab

Take a CBCT scan of the patient with AXEOS

1. The first scan will provide the patient bone situation

2. Scan with the prosthesis in place that has dual scan markers

3. Make the diagnosis

Scan:

Select patient in Sidexis 4 Software

Select Field of View and exposure mode on Axeos

Patient is positioned, and exposure started

Note for Full Arch

1. Scan patient wearing denture with radiopaque markers and a bite index to stabilize the denture and separate the jaws

2. Scan the denture alone (Dual Scan)

Examine:

CBCT Scan is automatically sent to Sidexis 4

Clinician examines images

Take a CBCT scan of the prosthesis with AXEOS

The second scan of the prosthesis with dual scan markers will provide mucosa information of the patient

For fully edentulous cases

Scan:

Start Connect Software and add/select Patient Data

Choose indication

Take an intraoral scan with Primescan (lower jaw, upper jaw and buccal bite registration)

Examine:

Check the scan data and discuss treatment plan with patient

Provide the scan data

Export the CBCT scan (DICOM file) from Sidexis software and send it to the laboratory

Share: 3D Imaging - Axeos

Images are exported and share with lab through a HIPAA-compliant server (e.g., Dropbox)

Share: Digital Impressions - Primescan

Case upload will take place automatically

Choose lab and fill in order data

Final check of order data and order submission

Note: In case of the lab partner does not use DS CAD/CAM Lab software (InLab), they can access a digital Impression from Primescan via Inbox (web-based platform).

Import files to Simplant Pro

1. CBCT scan (DICOM file)

2. Dual scan of prosthesis (DICOM file)

Lab starts case preparation in Simplant Pro and opens the 3D imaging data for the patient, then matches the 3D imaging data of the prosthesis with the Dual Scan wizard in Simplant Pro.

Plan the implant in Simplant Pro

1. Add implants into the image according to bone situation and prosthetic outcome

2. Add restorative components

3. Create the surgical guide preview

4. Get an approval from the dentist for your planning

Based on prosthetic set-up and available bone, lab plans implant sizes and positions as well as abutments and/or temporary cylinders

Plan is shared with Clinician via Simplant Viewer or screen sharing for Clinical Approval

Discuss immediate vs. delayed implant placement

If necessary, augmentation can be planned including measurement of regen material volumes

Order the surgical guide

1. Upload files to orderdigitalsolutions.com and place the order

2. Order the Simplant Core File in case you planned restorative components

Case upload will take place automatically after completing the "Request Simplant Guide" wizard in Simplant Pro.

Login to the Web Order pages, fill in case details, choose Simplant Guide or Simplant Guide File, add the Simplant Core File and submit order.

Dentsply Sirona is creating designs

Simplant Guide File

Simplant Core File

The Simplant Guide is designed by Dentsply Sirona.

Your restorative component planning in Simplant Pro will be used for the Simplant Core File export by Dentsply Sirona.

Download guide file and core file

Download following files from orderdigitalsolutions.com:

1. Simplant Guide File (STL file)

2. Simplant Core File (STL file)

Design the temporary restoration

Design the temporary restoration in your preferred lab software based on the temporary component that was planned in Simplant Pro

Following steps can be done:

1. Adapt prosthetic set-up (flanges)

2. Create holes for Temporary components

Manufacture the surgical guide

1. Transfer the guide file to your printing software

2. Print the surgical guide

Fabricate:

Once planning is approved, lab finalizes design and orders:

Simplant Guide File and sleeves to print Simplant SAFE guide and Simplant Core File to design and mill temporary bridge out of DS Multilayer PMMA

Manufacture the temporary restoration

1. Send design file of the temporary restoration from the lab software to your lab manufacturing software​

2. Mill the temporary restoration (Material: PMMA)

Fabricate

Once planning is approved, lab finalizes design and orders:

Simplant Guide File and sleeves to print Simplant SAFE guide and Simplant Core File to design and mill temporary bridge out of DS Multilayer PMMA

Provide surgical guide and a temporary restoration kit

1. Provide the surgical guide to the dentist

2. Provide a digitally designed temporary restoration kit to the dentist:

• Temporary restoration
• Temporary components (Temp cylinder/MultiBase abutments, Screws)
• Composite material / glue

Extract tooth

Perform tooth extractions if needed

Extract:

Note: for Full Arch cases, extractions are performed AFTER implant placement to permit the use of a tooth-supported guide.

Perform augmentation with OSSIX products

OSSIX

Immediate grafting:

After extraction and implant placement:

• If gap between bone and implant is smaller than 2mm, use OSSIX Volumax scaffold

• If gap is larger than 2mm, use OSSIX Bone with or without membrane. Choose between OSSIX Plus or OSSIX Volumax depending on the gingival phenotype.

Socket preservation:

After extraction, graft socket using OSSIX Bone

If more than one wall is missing, the use of OSSIX Plus over OSSIX Bone is recommended

Size of cube can be chosen during surgical planning

Place the implant with the Surgical Guide

1. Install the Simplant Guide onto the jaw

2. Select the correct implant diameter and length

3. Prepare your instruments for the surgical procedure

4. Follow the surgical protocol for the guided surgery

Place:

Prepare the osteotomy with drills according to the drilling protocol

Pick up the implant with the Implant Driver EV for Guided Surgery

Install the implant with the Implant Driver EV for Guided Surgery using the drilling unit or manually with Torque Wrench

Implants with EV connection:

Astra Tech Implant EV

PrimeTaper EV Implant

OmniTaper EV Implant

Note: for Full Arch cases, install the Simplant Guide onto the jaw with the help of the bite index and secure the guide with fixation screws.

Place the temporary restoration

Place the Temporary Components and attach the temporary restoration utilizing the composite material from the lab

Full Arch:

Multibase Abutments + Temp Cylinders + temporary bridge

Place MultiBase abutments on the implants and tighten the abutment screw

Place the Temp Cylinders on top of the MultiBase abutments.

Protect surgical site around cylinders with Polymerization sleeves.

Place pre-operatively fabricated temporary bridge on cylinders with the help of the bite index fabricated by your lab and fi xate on cylinders with resin.

Remove construction, polish and reposition tightening the Temp Cylinder Screws

Take final intraoral scan with Primescan

1. A scan will provide tooth, implant and mucosa information of the patient

2. Use IO FLO-S scan bodies for intraoral multiple teeth scanning

Scan:

Launch Connect Software and select Patient Data

Choose indication

Take an intraoral scan with Primescan (lower jaw, upper jaw, buccal bite registration)

Full arch:

Scan the patient with the temporary restoration in place

Remove temporary restoration and the Temporary Cylinders, leaving the MultiBase abutments in place

Scan the patient only with the MultiBase abutments in place

Insert the abutment level IO-FLO-S onto the MultiBase abutments and take a third scan on the “scanbody upper jaw” and/or “scan body lower jaw” catalog following the scan protocol

Reinstall the temporary restoration

Provide the intraoral scan data

Export the intraoral scan (STL file) from Connect software and send it to the laboratory

Upload scans and order the Atlantis BridgeBase

1. Lab uses Atlantis Scan Upload to transfer the STL´s to Atlantis WebOrder and finalize the order

2. Order the Atlantis BridgeBase via Atlantis WebOrder

Order:

Case upload will take place automatically in Connect after login

Choose lab, fill in order data and submit order

Note: If the lab partner does not use DS CAD/CAM Lab software (inLab), they can access a Digital Impression from Primescan via Inbox (web-based platform).

Lab will order a final Atlantis BridgeBase. Lab will finish the design and mill a Cercon ht ML BridgeBase esthetic secondary structure based on a Atlantis Core File.

Download Atlantis BridgeBase core file

Download the BridgeBase core file from Atlantis WebOrder

The core file includes: Scanjaw, Atlantis BridgeBase, Screwchannels and Diagnostic teeth set-up

Order:

Case upload will take place automatically in Connect after login

Choose lab, fill in order data and submit order

Note: If the lab partner does not use DS CAD/CAM Lab software (inLab), they can access a Digital Impression from Primescan via Inbox (web-based platform).

Lab will order a final Atlantis BridgeBase. Lab will finish the design and mill a Cercon ht ML BridgeBase esthetic secondary structure based on a Atlantis Core File.

Design the "secondary" of the final restoration

1. Import the Atlantis BridgeBase core file into your preferred lab software

2. Design the “secondary” based on Atlantis BridgeBase core file while the BridgeBase is being produced

Manufacture the "secondary" and create final restoration

1. Transfer the restoration design to your milling software

2. Use DS Multilayer PMMA  for a try-in/temporary

3. Use DS Cercon ht ML and mill the final zirconia restoration

4. Finalize the restoration with Celtra Ceram (veneering ceramic) and DS Stain & Glaze

Provide the final restoration

Cement the secondary onto the Atlantis BridgeBase and send it to the dentist

Place the final restoration

1. Remove the temporary restoration from the patient’s mouth

2. Place the final restoration you received from your laboratory

3. Method: screw-retained

Install:

The lab will deliver the Atlantis BridgeBase restoration, complete with final esthetic secondary structure cemented on the metal suprastructure

Remove the temporary restoration and the Temporary Cylinders, leaving the MultiBase abutments in place

Secure the complete restoration and tighten the Atlantis BridgeBase with the bridge screws